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Long-term disability and return to work.

In a study of 2,113 physically or mentally disabled adults, an early return to stable employment was found to be largely dependent on two interrelated factors: motivation for work and the duration of unemployment before rehabilitation. If doctors refer such patients for medical and vocational rehabilitation at the earliest opportunity, they can help to reduce the period of unemployment and to restore patients' confidence and motivation.

Adolescent↗

Two patients with occupational asthma who returned to work with dust respirators.

OBJECTIVES: To assess the efficacy of dust respirators in preventing asthma attacks in patients with occupational asthma (asthma induced by buckwheat flour or wheat flour). METHODS: The effect of the work environment was examined in two patients with occupational asthma with and without the use of a commercially available mask or a dust respirator. Pulmonary function tests were performed immediately before and after work and at 1 hourly intervals for 14 hours after returning to the hospital. RESULTS: In patient 1, environmental exposure resulted in no symptoms during and immediately after work, but coughing, wheezing, and dyspnoea developed after 6 hours. Peak expiratory flow rate (PEFR) decreased by 44% 7 hours after leaving the work environment, showing only a positive late asthmatic reaction (LAR). In patient 2, environmental exposure resulted in coughing and wheezing 10 minutes after initiation during bread making, and PEFR decreased by 39%. After 7 hours, PEFR decreased by 34%. The environmental provocation tests in both patients were repeated after wearing a commercial respiratory. This resulted in a complete suppression of LAR in patient 1 and of immediate asthmatic reaction (IAR) and LAR in patient 2. CONCLUSIONS: Two patients with asthma induced by buckwheat flour or wheat flour in whom asthmatic attacks could be prevented with a dust respirator are reported. Dust respirators are effective in preventing asthma attacks induced by buckwheat flour and wheat flour.

Adult↗

Early return to work following highly selective vagotomy.

In the Royal Navy, after surgery, the time that servicemen spend away from work and the level of duty to which they return are decisions made by the surgeon, not the general practitioner. In a prospective study, we have thus been able to assess the acceptability of return to full duty at decreasing intervals after highly selective vagotomy (HSV). Seventy-eight servicemen who underwent HSV for duodenal ulcer were studied in three periods, 1978-1980, 1981-1982, 1983-1986, each with a shorter interval to return to duty. There were no differences in the rates of ulcer recurrence, incisional hernia, or ability to perform full duties. After HSV the mean time to return to full duties for each group was 29.3, 16.4, and 4.2 weeks, respectively. Every patient returned to full duties at 28 days was able to perform any assigned task whether at sea or ashore.

Adult↗